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Impact of HIV Infection on Colorectal Tumors: A Prospective Colonoscopic Study of Asian Patients

Hamada, Yohei MD*; Nagata, Naoyoshi MD; Nishijima, Takeshi MD*,‡; Shimbo, Takuro MD, PhD§; Asayama, Naoki MD; Kishida, Yoshihiro MD; Sekine, Katsunori MD; Tanaka, Shohei MD; Aoki, Tomonori MD; Watanabe, Kazuhiro MD; Akiyama, Junichi MD; Igari, Toru MD; Mizokami, Masashi MD, PhD; Uemura, Naomi MD, PhD#; Oka, Shinichi MD, PhD*,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2014 - Volume 65 - Issue 3 - p 312–317
doi: 10.1097/QAI.0000000000000016
Clinical Science

Background: Non-AIDS defining cancer has recently become a major problem in HIV-infected patients. Little has been reported on whether HIV infection is a risk factor for colorectal adenoma, especially in Asians.

Methods: The study was conducted under a prospective cross-sectional design and included all adults who underwent colonoscopy. Subjects were matched by age and sex to compare the prevalence of colorectal adenoma, adenocarcinoma, polyps, and other tumors. Detailed risk factors were assessed, including lifestyle habits, medications, comorbidities, gastrointestinal symptom rating scale, HIV-associated factors, and human papillomavirus infection. To evaluate the effects of HIV infection on adenoma, the odds ratio (OR) was estimated by multivariate logistic regression.

Results: A total of 177 HIV-infected patients and 177 controls were selected for analysis. No significant difference was noted in the prevalence of adenoma (n = 29 vs. 40, P = 0.14). Multivariate analysis adjusted by baseline demographics and risk factors showed that HIV is not associated with increased risk of adenoma (adjusted OR = 0.66, P = 0.16). Kaposi’s sarcoma was more common in HIV-infected patients (n = 6 vs. 0, P = 0.03). Among HIV-infected patients, advanced age was an independent and significant risk factor for adenoma (adjusted OR = 2.28, P < 0.01). CD4 count, HIV-RNA, history of antiretroviral treatment, and oncogenic human papillomavirus infection were not risk factors for adenoma.

Conclusions: HIV infection was not identified as risk for adenoma in Asian patients. However, advanced age was independently associated with increased risk of adenoma. HIV-infected patients should not miss screening opportunity for colorectal adenoma and other gastrointestinal malignancies.

*AIDS Clinical Center and

Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan;

Center for AIDS Research, Kumamoto University, Kumamoto, Japan;

§Research and Informatics, International Clinical Research Center Research Institute, and

Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan; and

The Research Center for Hepatitis and Immunology, Department of Gastroenterology and Hepatology, and

#Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.

Correspondence to: Naoyoshi Nagata, MD, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan (e-mail:

The authors have no conflicts of interest to disclose.

Supported by Grants-in Aid for AIDS research from the Japanese Ministry of Health, Labor, and Welfare (H23-AIDS-001) and the Global Center of Excellence Program (Global Education and Research Center Aiming at the Control of AIDS) from the Japanese Ministry of Education, Science, Sports, and Culture.

Received July 09, 2013

Accepted September 20, 2013

© 2014 by Lippincott Williams & Wilkins